Massage involves working and acting on the body with pressure – structured, unstructured, stationary, or moving – tension, motion, or vibration, done manually or with mechanical aids. Massage can be applied with the hands, fingers, elbows, knees, forearm, feet, or a massage device. Depending on the application and technique used, massage is used to promote relaxation and well-being,[1][2] and is beneficial in treating sports injuries[3] and other problems affecting the musculature of the body such as postural misalignment and many painful conditions.[4] Massage can also be sexual in nature (see Erotic massage).

In professional settings massage clients are treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor, while in amateur settings a general purpose surface like a bed or floor is more common. Aquatic massage and bodywork is performed with recipients submersed or floating in a warm-water therapy pool. The massage subject may be fully or partially clothed or unclothed.

The word comes from the French massage "friction of kneading", or from Arabicmassa meaning "to touch, feel" or from Latinmassa meaning "mass, dough",[5][6] cf. Greek verb μάσσω (massō) "to handle, touch, to work with the hands, to knead dough".[7] In distinction the ancient Greek word for massage was anatripsis,[8] and the Latin was frictio.

BC 2330: The Tomb of Akmanthor [9] (also known as "The Tomb of the Physician") in Saqqara, Egypt depicts two men having work done on their feet and hands, presumably massage.

Akmanthor

BC 722-481: Huangdi Neijing is composed during the Chinese Spring and Autumn period (the beginning of recorded history). The Nei-jing is a compilation of medical knowledge known up to that date, and is the foundation of Traditional Chinese Medicine. Massage is referred to in 30 different chapters of the Nei Jing. It specifies the use of different massage techniques and how they should be used in the treatment of specific ailments, and injuries. Also known as "The Yellow Emperor's Inner Canon", the text refers to previous medical knowledge from the time of the Yellow Emperor (approx 2700 BC), misleading some into believing the text itself was written during the time of the Yellow Emperor (which would predate written history).[10][11]

BC 300 Charaka Samhita believed to be the oldest of the three ancient treatises of Ayurvedic medicine, including massage. Sanskrit records indicate that massage had been practiced in India long before the beginning of recorded history.[14]

AD 581: China establishes a department of massage therapy within the Office of Imperial Physicians.

Middle-Ages: Medical knowledge, including that of massage, made its way from Rome to Persia in the Middle Ages.[citation needed] Many of Galen's manuscripts, for instance, were collected and translated by Hunayn ibn Ishaq in the 9th century. Later in the 11th century copies were translated back into Latin, and again in the 15th and 16th centuries, when they helped enlighten European scholars as to the achievements of the Ancient Greeks. This renewal of the Galenic tradition during the Renaissance played a very important part in the rise of modern science.

One of the greatest Persian medics was Avicenna, also known as Ibn Sina, who lived from 980AD to 1037AD. He was the foremost philosopher of medieval Islam and also a great philosopher, logician and medic.[citation needed] His works included a comprehensive collection and systematisation of the fragmentary and unorganised Greco-Roman medical literature that had been translated Arabic by that time, augmented by notes from his own experiences. One of his books, Al-Qānūn fī aṭ-Ṭibb (The Canon of Medicine) has been called the most famous single book in the history of medicine in both East and West. Avicenna excelled in the logical assessment of conditions and comparison of symptoms and took special note of analgesics and their proper use as well as other methods of relieving pain, including massage.

AD 1150: Evidence of massage abortion, involving the application of pressure to the pregnant abdomen, can be found in one of the bas reliefs decorating the temple of Angkor Wat in Cambodia. It depicts a demon performing such an abortion upon a woman who has been sent to the underworld. This is the oldest known visual representation of abortion.[15]

AD 1776: Jean Joseph Marie Amiot, and Pierre-Martial Cibot, French missionaries in China translate summaries of Huangdi Neijing, including a list of medical plants, exercises and elaborate massage techniques, into the French language, thereby introducing Europe to the highly developed Chinese system of medicine, medical-gymnastics, and medical-massage.[11]

AD 1776 Pehr Henrik Ling, a Swedish physical therapist, and teacher of medical-gymnastics is born. Ling has often been erroneously credited for having invented "Classic Massage" aka "Swedish Massage", and has been called the "Father of Massage".[16]

AD 1779: Frenchman Pierre-Martial Cibot publishes ‘Notice du Cong-fou des Bonzes Tao-see' also known as "The Cong-Fou of the Tao-Tse", a French language summary of medical techniques used by Taoist priests. According to Joseph Needhan, Cibot's work "was intended to present the physicists and physicians of Europe with a sketch of a system of medical gymnastics which they might like to adopt—or if they found it at fault they might be stimulated to invent something better. This work has long been regarded as of cardinal importance in the history of physiotherapy because it almost certainly influenced the Swedish founder of the modern phase of the art, Per Hendrik Ling. Cibot had studied at least one Chinese book, but also got much from a Christian neophyte who had become expert in the subject before his conversion."[17]

AD 1813 The Royal Gymnastic Central Institute for the training of gymnastic instructors was opened in Stockholm, Sweden, with Pehr Henrik Ling appointed as principal. Ling developed what he called the "Swedish Movement Cure." Ling died in 1839, having previously named his pupils as the repositories of his teaching. Ling and his assistants left little proper written account of their methods. [11][18][19]

China: Massage has developed continuously in China for over 5000 years.[citation needed] Western ideas are considered within the traditional framework. It is widely practiced and taught in hospital and medical schools and is an essential part of health maintenance and primary healthcare.[20]

During the 1930s and 1940s massage's influence decreased as a result of medical advancements of the time, while in the 1970s massage's influence grew once again with a notable rise among athletes.[13] Until the 1970s, nurses used massage to reduce pain and aid sleep.[21] The massage therapy industry is continuously increasing, with a projected 19% increase between 2008 and 2009. U.S. consumers spend between $4 and $6 billion on visits to massage therapists, as of 2009.[22]

United Kingdom: Massage is popular in the United Kingdom today and gaining in popularity. There are many private practitioners working from their own premises as well as those who operate from commercial venues.

Massage in sports, business and organizations: Massage developed alongside athletics in both Ancient China and Ancient Greece. Taoist priests developed massage in concert with their Kung Fugymnastic movements, while Ancient Greek Olympians used a specific type of trainer ("aleiptes")[23] who would rub their muscles with oil. Pehr Ling's introduction to massage also came about directly as a result of his study of gymnastic movements.

Active release technique (ART) is a form of deep tissue manipulation patented by P. Michael Leahy in which specified techniques are used to release what are presumed to be soft tissue adhesions.[26]:578

Acupressure [from Latin acus "needle" (see acuity) + pressure (n.)[27]] is an alternative medicine technique similar in principle to acupuncture. It is based on the concept of life energy which flows through "meridians" in the body. In treatment, physical pressure is applied to acupuncture points with the aim of clearing blockages in these meridians. Pressure may be applied by hand, by elbow, or with various devices.

Some medical studies have suggested that acupressure may be effective at helping manage nausea and vomiting, for helping lower back pain, tension headaches, stomach ache, among other things, although such studies have been found to have a high likelihood of bias.[28]

Aquatic bodywork comprises a diverse set of massage and bodywork forms performed in water. This includes land-based forms performed in water (e.g., Aquatic Craniosacral Therapy, Aquatic Myofascial Release Therapy, etc.), as well as forms specific to warm water pools (e.g., Aquatic Integration, Dolphin Dance, Healing Dance, Jahara technique, WaterDance, Watsu).[29]

In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese, ashi for foot and atsu for pressure.[30] This technique typically uses the heel, sesamoid, arch and/or whole plantar surface of foot, and offers large compression, tension and shear forces with less pressure than an elbow, and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions.[31] Other manual therapy techniques using the feet to provide treatment include Keralite, Barefoot Lomi Lomi, Chavutti Thirumal.

Ayurvedic Massage known as Abhyangam in Sanskrit is one of the most common and important Ayurvedic therapies. According to the Ayurvedic Classics Abhayngam is an important dincharya (Daily Regimen) that is needed for maintaining a healthy lifestyle. The massage technique used during Ayurvedic Massage is known to stimulate the lymphatic system to expel the toxins out from the body. The Ayurvedic Massage also stimulates production of lymphocytes which play a vital role in maintaining the immunity in human body. Thus regular Ayurvedic Massage can lead to better immunity and also help in body de-toxification. The other benefits of regular Ayurvedic Massage include pain relief, reduction of fatigue, prevention of ageing and bestowing longevity.[32][33]

Biodynamic massage was created by Gerda Boyesen as part of Biodynamic Psychotherapy. Practised as a stand-alone therapy, it is a combination of physical and energy work and also uses a stethoscope to hear the peristalsis.[34]

While various types of reflexology related massage styles focus on the feet, massage of (usually) the soles of the feet is often performed purely for relaxation or recreation. It is believed there are some specific points on our feet that correspond to different organs in the body. Stimulation of these points during foot massage can cause significant reduction in pain. Studies also suggest that foot reflexology massage can reduce fatigue and promote better sleep.[36]

Lomilomi is the traditional massage of Hawaii. As an indigenous practice, it varies by island and by family. The word lomilomi also is used for massage in Samoa and East Futuna. In Samoa, it is also known as lolomi and milimili. In East Futuna, it is also called milimili, fakasolosolo, amoamo, lusilusi, kinikini, fai’ua. The Māori call it roromi and mirimiri. In Tonga massage is fotofota, tolotolo, and amoamo. In Tahiti it is rumirumi. On Nanumea in Tuvalu, massage is known as popo, pressure application is kukumi, and heat application is tutu. Massage has also been documented in Tikopia in the Solomon Islands, in Rarotonga and in Pukapuka in Western Samoa.[37]

Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling. The lymphatic system is a network of slow moving vessels in the body that carries cellular waste toward the heart, to be filtered and removed. Lymph also carries lymphocytes, and other immune system agents. Manual lymphatic drainage claims to improve waste removal and immune function.[38][39][40]

Medical Massage is a controversial term in the massage profession.[41] Many use it to describe a specific technique. Others use it to describe a general category of massage and many methods such as deep tissue massage, myofascial release and triggerpoint therapy as well as osteopathic techniques, cranial-sacral techniques and many more can be used to work with various medical conditions.

A 2004 systematic review found single applications of massage therapy "reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level", while "multiple applications reduced delayed assessment of pain", and found improvements in anxiety and depression similar to effects of psychotherapy.[44] A subsequent systematic review published in 2008 found that there is little evidence supporting the use of massage therapy for depression in high quality studies from randomized controlled trials.[45]

Myofascial release refers to the manual massage technique that claims to release adhered fascia and muscles with the goal of eliminating pain, increasing range of motion and equilibrioception. Myofascial release usually involves applying shear compression or tension in various directions, cross fiber friction or by skin rolling.[46]

Shiatsu (指圧) (shi meaning finger and atsu meaning pressure) is a type of alternative medicine consisting of the fingers and palm pressure, stretches, and other massage techniques. There is no convincing data available to suggest that shiatsu is an effective treatment for any medical condition.[47]

A hot stone massage

Massage trainer teaches sports students how to do massage (Leipzig, German Democratic Republic)

Structural Integration's aim is to unwind the strain patterns residing in the body's myofascial system, restoring it to its natural balance, alignment, length, and ease. This is accomplished by deep, slow, fascial and myofascial manipulation, coupled with movement re-education. Various brands of Structural Integration are Rolfing, Hellerwork, Guild for Structural Integration, Aston Patterning,[11] Soma,[48] and Kinesis Myofascial Integration.[49]

The most widely recognized and commonly used category of massage is the Swedish massage. The Swedish massage techniques vary from light to vigorous.[50] Swedish massage uses five styles of strokes. The five basic strokes are effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross fiber or with the fibers) and vibration/shaking.[51] Swedish massage has shown to be helpful in reducing pain, joint stiffness, and improving function in patients with osteoarthritis of the knee over a period of eight weeks.[52] The development of Swedish massage is often inaccurately credited to Per Henrik Ling, though the Dutch practitioner Johann Georg Mezger applied the French terms to name the basic strokes.[53] The term "Swedish" massage is actually only recognized in English and Dutch speaking countries, and in Hungary. Elsewhere the style is referred to as "classic massage".

Clinical studies report that Swedish Massage can effectively reduce low back pain and the effectiveness can last for as long as 15 weeks. One study reported that Swedish Massage caused reduction in salivary cortisol indicating its role in management of stress and improvement in mood.[54][55]

Known in Thailand as นวดแผนโบราณ (Nuat phaen boran,IPA:[nûət pʰɛ́ːn boːraːn]), meaning "ancient/traditional massage", Traditional Thai massage (Nuad Boran) is generally based on a combination of Indian and Chinese traditions of medicine.

Thai massage – or Nuat Thai – combines both physical and energetic aspects. It is a deep, full-body massage progressing from the feet up, and focusing on sen or energy lines throughout the body, with the aim of clearing blockages in these lines, and thus stimulating the flow of blood and lymph throughout the body. It draws on yoga, acupressure and reflexology.

Thai Massage is a popular massage therapy that is used for management of conditions such as musculoskeletal pain and fatigue. Thai Massage involves a number of stretching movements that improve body flexibility, joint movement and also improve blood circulation throughout the body. In one study scientists found that Thai Massage showed comparable efficacy as the painkiller ibuprofen in reduction of joint pain caused by osteoarthritis (OA) of the knee.[56]

Massage of Chinese Medicine is known as An Mo (按摩, pressing and rubbing) or Qigong Massage, and is the foundation of Japan's Anma. Categories include Pu Tong An Mo (general massage), Tui Na An Mo (pushing and grasping massage), Dian Xue An Mo (cavity pressing massage), and Qi An Mo (energy massage). Tui na (推拿) focuses on pushing, stretching, and kneading muscles, and Zhi Ya (指壓) focuses on pinching and pressing at acupressure points. Technique such as friction and vibration are used as well.[57]

Sometimes confused with pressure point massage,[13] this involves deactivating trigger points that may cause local pain or refer pain and other sensations, such as headaches, in other parts of the body. Manual pressure, vibration, injection, or other treatment is applied to these points to relieve myofascial pain. Trigger points were first discovered and mapped by Janet G. Travell (President Kennedy's physician) and David Simons. Trigger points have been photomicrographed and measured electrically.[58] and in 2007 a paper was presented showing images of Trigger Points using MRI.[59] These points relate to dysfunction in the myoneural junction, also called neuromuscular junction (NMJ), in muscle, and therefore this technique is different from reflexology, acupressure and pressure point massage.

Watsu, developed by Harold Dull at Harbin Hot Springs, California, is a type of aquatic bodywork performed in near-body-temperature water, and characterized by continuous support by the practitioner and gentle movement, including rocking, stretching of limbs, and massage. The technique combines hydrotherapy floating and immersion with shiatsu and other massage techniques. Watsu is used as a form of aquatic therapy for deep relaxation and other therapeutic intent. Related forms include WaterDance, Healing Dance, and Jahara technique.[60][61]

Specialized massage tables and chairs are used to position recipients during massages. A typical commercial massage table has an easily cleaned, heavily padded surface, and a horseshoe-shaped head support that allows the client to breathe easily while lying face down and can be stationary or portable, while home versions are often lighter weight or designed to fold away easily. An orthopedic pillow or bolster can be used to correct body positioning.

Ergonomic chairs serve a similar function as a massage table. Chairs may be either stationary or portable models. Massage chairs are easier to transport than massage tables, and recipients do not need to disrobe to receive a chair massage. Due to these two factors, chair massage is often performed in settings such as corporate offices, outdoor festivals, shopping malls, and other public locations.

Temperature-controlled warm-water therapy pools are used to perform aquatic bodywork.[62] For example, Watsu requires a warm-water therapy pool that is approximately chest deep (depending on height of the therapist) and temperature-controlled to about 35 °C (95 °F).[63]

A dry-water massage table uses jets of water to perform the massage of the client's muscles. These tables differ from a Vichy shower in that the client usually stays dry. Two common types are one in which the client lies on a waterbed-like mattress which contains warm water and jets of water and air bubbles and one in which the client lies on a foam pad and is covered by a plastic sheet and is then sprayed by jets of warm water, similar to a Vichy shower.[64] The first type is sometimes seen available for use in malls and shopping centers for a small fee.

A Vichy shower is a form of hydrotherapy which uses a series of shower nozzles which spray large quantities of water over the client while they lie in a shallow wet bed, similar to a massage table, but with drainage for the water. The nozzles may usually be adjusted for height, direction, and temperature to suit the client's needs.

Many different types of massage cremes, lotions, gels, and oils are used to lubricate and moisturize the skin and reduce the friction between skin ( hands of technician and client). lightly different properties, and the choice depends upon the type of massage and the therapist's preference. Commonly used oils include jojoba oil, fractionated coconut oil, grape seed oil, olive oil, almond oil, macadamia oil, sesame oil, pecan oil, mustard oil[65] and (mineral) baby oil.[66] Each oil has different properties and serves different purposes. There are different views about the extent to which various oils and other substances are absorbed into the body through the skin.[67] Salts are also used in association with oils to remove dry skin.

A body rock is a serpentine-shaped tool, usually carved out of stone. It is used to amplify the therapist's strength and focus pressure on certain areas. It can be used directly on the skin with a lubricant such as oil or corn starch or directly over clothing.

Bamboo and rosewood tools are also commonly implemented. They originate from practices in southeast Asia, Thailand, Cambodia, and Burma. Some of them may be heated, oiled, or wrapped in cloth.

Practitioner associations and official recognition of professionals[edit]

The US based National Center for Complementary and Alternative Medicine recognizes over eighty different massage techniques.[13] The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness.[68]

Many types of practices are associated with massage and include bodywork, manual therapy, energy medicine, and breathwork. Other names for massage and related practices include hands-on work, body/somatic therapy, and somatic movement education. Body-mind integration techniques stress self-awareness and movement over physical manipulations by a practitioner. Therapies related to movement awareness/education are closer to Dance and movement therapies. Massage can also have connections with the New Age movement and alternative medicine as well as holistice philosophies of preventative medical care, as well as being used by mainstream medical practitioners.

Pain relief: Relief from pain due to musculoskeletal injuries and other causes is cited as a major benefit of massage.[13]Acupressure or pressure point massage may be more beneficial than classic Swedish massage in relieving back pain.[72][needs update] However, a meta-study conducted by scientists at the University of Illinois at Urbana-Champaign failed to find a statistically significant reduction in pain immediately following treatment.[69]

State anxiety: Massage has been shown to reduce state anxiety, a transient measure of anxiety in a given situation.[69]

Pain relief: When combined with education and exercises, massage might help sub-acute, chronic, non-specific low back pain.[72] Furthermore, massage has been shown to reduce pain experienced in the days or weeks after treatment.[69]

Trait anxiety: Massage has been shown to reduce trait anxiety; a person's general susceptibility to anxiety.[69]

Depression: Massage has been shown to reduce subclinical depression.[69]

Massage has been shown to reduce neuromuscular excitability by measuring changes in the Hoffman's reflex (H-reflex) amplitude. A decrease in peak-to-peak H-reflex amplitude suggests a decrease in motoneuron excitability.[73] Others explain, "H-reflex is considered to be the electrical analogue of the stretch reflex...and the reduction" is due to a decrease in spinal reflex excitability.[74] Field (2007) confirms that the inhibitory effects are due to deep tissue receptors and not superficial cutaneous receptors, as there was no decrease in H-reflex when looking at light fingertip pressure massage.[75] It has been noted that "the receptors activated during massage are specific to the muscle being massaged", as other muscles did not produce a decrease in H-reflex amplitude.[73]

Proprioceptive studies are much more abundant than massage and proprioception combined, yet researchers are still trying to pinpoint the exact mechanisms and pathways involved to get a fuller understanding.[76] Proprioception may be very helpful in rehabilitation, though this is a fairly unknown characteristic of proprioception, and "current exercises aimed at 'improving proprioception' have not been demonstrated to achieve that goal".[77] Up until this point, very little has been studied looking into the effects of massage on proprioception. Some researchers believe "documenting what happens under the skin, bioelectrically and biochemically, will be enabled by newer, non-invasive technology such as functional magnetic resonance imaging and continuous plasma sampling" .[75]

Most types of massage, with the exception of some traditional Chinese medicine are not regulated in China. Although illegal in China, some of the smaller businesses are fronts for prostitution.[80] These are called falangmei (发廊妹 "hairdressing salon sisters").

In Germany massage is regulated by the government on a federal and national level. Only someone who has completed 3,200 hours of training (theoretical and practical) can use the professional title "Masseur und Medizinischer Bademeister" or Medical Masseur and Spa Therapist. This person can prolong his training depending on the length of professional experience to a Physiotherapist (1 year to 18 months additional training). The Masseur is trained in Classical Massage, Myofascial Massage, Exercise and Movement Therapy. During the training they will study: Anatomy, Physiology, Pathology, Gynecology, Podiatry, Psychiatry, Psychology, Surgery, and probably most importantly Dermiatry and Orthopedics. They are trained in Electrotherapy, and Hydrotherapy. Hydrotherapy includes: Kneipp, Wraps, underwater Massage, therapeutic washing, Sauna and Steambath. A small part of their training will include special forms of massage which are decided by the local college, for example: Foot reflex zone massage, Thai Massage etc. Finally a graduate is allowed to treat patients under the direction of a doctor. He is regulated by the professional body which regulates Physiotherapists. This includes the restriction on advertising and oath of confidentiality to clients.[citation needed]

In India, massage therapy is licensed by The Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) under the Ministry of Health and Family Welfare (India) in March 1995. Massage therapy is based on Ayurveda, the ancient medicinal system that evolved around 600 BC. In ayurveda, massage is part of a set of holistic medicinal practices, contrary to the independent massage system popular in some other systems. In Siddha, Tamil traditional medicine from south India, massage is termed as "Thokkanam" and is classified in to nine types, each for specific variety of disease.

In Japan, shiatsu is regulated but oil massage and Thai massage are not. Although prostitution is illegal, prostitutes posing as massage therapists in fashion health shops and pink salons are fairly common in the larger cities.

In Mexico massage therapists, called "sobadores", combine massage using oil or lotion[82] with a form of acupuncture and faith.[83]Sobadores are used to relieve digestive system problems as well as knee and back pain.[82][83] Many of these therapists work out of the back of a truck, with just a curtain for privacy.[83] By learning additional holistic healer's skills in addition to massage, the practitioner may become a curandero.[84]

In many parts of Mexico prostitution is legal and prostitutes are allowed to sell sexual massage. These businesses are often confined to a specific area of the city, such as the Zona Norte in Tijuana.

In New Zealand, massage is unregulated. There are two levels of registration with Massage New Zealand, the professional body for massage therapists within New Zealand, although neither of these levels are government recognised. Registration at the Certified Massage Therapist level denotes competency in the practice of relaxation massage. Registration at the Remedial massage therapist denotes competency in the practice of remedial or orthopedic massage. Both levels of registration are defined by agreed minimum competencies and minimum hours.[citation needed]

In South Africa, massage is regulated, but enforcement is poor. The minimum legal requirement to be able to practice as a professional massage therapist is a 2-year diploma in Therapeutic Massage and registration with The Allied Health Professions Council of SA (AHPCSA). The 2 year qualification includes 240 credits, about 80 case studies, and about 100 hours community service.

In Thailand, Thai massage is officially listed as one of the branches of traditional Thai medicine, recognized and regulated by the government. It is considered to be a medical discipline in its own right and is used for the treatment of a wide variety of ailments and conditions. Massage schools, centers, therapists, and practitioners are increasingly regulated by the Ministries of Education and Public Health in Thailand.[86][87]

According to research done by the American Massage Therapy Association, as of 2012 in the United States there are between 280,000 and 320,000 massage therapists and massage school students.[88] As of 2011, there were more than 300 accredited massage schools and programs in the United States.[89] Most states have licensing requirements that must be met before a practitioner can use the title "massage therapist", and some states and municipalities require a license to practice any form of massage. If a state does not have any massage laws then a practitioner need not apply for a license with the state. However, the practitioner will need to check whether any local or county laws cover massage therapy. Training programs in the US are typically 500–1000 hours in length, and can award a certificate, diploma, or degree depending on the particular school.[90] There are around 1,300 programs training massage therapists in the country and study will often include anatomy and physiology, kinesiology, massage techniques, first aid and CPR, business, ethical and legal issues, and hands on practice along with continuing education requirements if regulated.[13] The Commission on Massage Therapy Accreditation (COMTA) is one of the organizations that works with massage schools in the U.S. and currently (Aug 2012) there are approximately 300 schools that are accredited through this agency.

Forty-three states, the District of Columbia and five Canadian provinces currently offer some type of credential to professionals in the massage and bodywork field---usually licensure, certification or registration.[68][91] Thirty-eight states and the District of Columbia require some type of licensing for massage therapists.[92] In the US, 39 states use the National Certification Board for Therapeutic Massage and Bodywork's certification program as a basis for granting licenses either by rule or statute.[93] The National Board grants the designation Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). There are two tests available and one can become certified through a portfolio process with equivalent training and experience.[94] Between 10% and 20% of towns or counties regulate the profession.[79] The National Certification offered by the NCBTMB does not mean that you can practice massage in any state.[95] These local regulations can range from prohibition on opposite sex massage, fingerprinting and venereal checks from a doctor, to prohibition on house calls because of concern regarding sale of sexual services.[79][96]

In the US, licensure is the highest level of regulation and this restricts anyone without a license from practicing massage therapy or by calling themselves that protected title. Certification allows only those who meet certain educational criteria to use the protected title and registration only requires a listing of therapists who apply and meet an educational requirement.[96] It is important to note that a massage therapist may be certified, but not licensed. Licensing requirements vary per state, and often require additional criteria be met in addition to attending an accredited massage therapy school and passing a required state specified exam (basically the certification requirements in many states). In the US, most certifications are locally based.[97] However, as of March 2014, some states still do not require a license or a certification.[citation needed] However, this is thought to change eventually as more regulatory bodies governing the profession of massage are established in each state. Furthermore, some states allow license reciprocity where massage therapists who relocate can relatively easily obtain a license in their new state. Not all states provide this option.[98]

In late 2007, the Federation of State Massage Therapy Boards launched a new certification exam titled the MBLEx. Currently, 40 states have accepted this certification exam, along with the District of Columbia, Puerto Rico and the US Virgin Islands.

In 1997 there were an estimated 114 million visits to massage therapists in the US.[90] Massage therapy is the most used type of alternative medicine in hospitals in the United States.[68] Between July 2010 and July 2011 roughly 38 million adult Americans (18 percent) had a massage at least once.[99]

People state that they use massage because they believe that it relieves pain from musculoskeletal injuries and other causes of pain, reduces stress and enhances relaxation, rehabilitates sports injuries, decreases feelings of anxiety and depression, and increases general well being.[13]

The number of visits rose from 91 million in 1999 to 136 million in 2003, generating a revenue that equals $11 billion.[101] Job outlook for massage therapists is also projected to grow at 20% between 2010 and 2020 by the Bureau of Labor Statistics, or faster than average.[102]